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. 2023 Apr;15(2):159-165.
doi: 10.1177/17585732211065449. Epub 2021 Dec 15.

Open reduction and internal fixation of displaced head-split type humeral fractures and role of the rotator-interval approach

E Fleischhacker  1 , G Siebenbürger  1 , J Gleich  1 , T Helfen  1 , W Böcker  1 , B Ockert  1
Affiliations

Open reduction and internal fixation of displaced head-split type humeral fractures and role of the rotator-interval approach

E Fleischhacker et al. Shoulder Elbow. 2023 Apr.

Abstract

Background: Open reduction and internal fixation (ORIF) of humeral head split fractures is challenging because of high instability and limited visibility. The aim of this retrospective study was to investigate the extend of the approach through the rotator interval (RI) on the reduction quality and functional outcome.

Methods: 37 patients (mean age: 59 ± 16 years,16 female) treated by ORIF through a standard deltopectoral (DP) approach were evaluated. The follow-up period was at least two years. In 17 cases, the approach was extended through the RI. Evaluation was based on radiographs, Constant scores (CS) and DASH scores.

Results: In group DP, "anatomic" reduction was achieved in 9 cases (45%), "acceptable" in 5 cases (25%), and "malreduced" in 6 cases (30%). In group RI, "anatomic" reduction was seen in 12 cases (71%), "acceptable" in 5 cases (29%), and "malreduced" in none (p = 0.04). In the DP group, the CS was 60.2 ± 16.2 and the %CS was 63.9 ± 22.3, while in the RI group, the CS was 74.5 ± 17.4 and the %CS was 79.1 ± 24.1 (p = 0.07, p = 0.08). DASH score was 22.8 ± 19.5 in DP compared to RI: 25.2 ± 20.6 (p = 0.53).

Conclusions: The RI approach improves visualization as it enhances quality of fracture reduction, however functional outcomes may not differ significantly.

Type of study and level of proof: Retrospective, level III.

Keywords: avascular necrosis; constant-score; head-split; humerus fracture; osteosynthesis.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ct images of patients with headsplit fractures included in the study: dislocated (>5 mm) fractures (arrows) located >5 mm within the cartilaginous articular surface. Left, 3D reconstruction of a CT scan; right, a coronal slice.
Figure 2.
Figure 2.
Establishing the rotator interval approach
See this image and copyright information in PMC

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